Stress and adaptational outcomes: The problem of confounded measures.

Notes that confounding is a major source of uneasiness among many who do research on the relationship between stress and adaptational outcomes such as psychological symptoms and somatic health. A commonly proposed solution, illustrated by B. S. Dohrenwend et al (see record 1984-22172-001), is to purify the independent variable, stress, by focusing on its environmental aspects and by making it independent of psychological response variables such as perceptions or appraisals. It is argued that such a solution, however, is neither possible nor desirable, and it obviates relational, cognitive theories of psychological stress. The present authors examine the problem of confounding and circularity in stress research and reanalyze data obtained by A. D. Kanner et al (1981) and the 2nd author et al (see record 1983-05622-001) in light of the Dohrenwend et al findings. It is concluded that the appraisal process should not and cannot be removed in the measurement of psychological stress, and therefore some confounding is inevitable. (50 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The advanced practice nurse role in implementing and evaluating two nurse-managed wellness clinics: lessons learned about structure, process, and outcomes

By the year 2000, the baby boom generation will be reaching its sixth decade and 34 million U.S. citizens will be over the age of 65. One strategy for promoting healthy aging is having older persons participate in health promotion programs. Nurse-managed wellness clinics (NMWCs) staffed by advanced practice nurses (APNs) offer an option for health promotion among older individuals. This article describes the APN role in implementing and evaluating two NMWCs for older people living in urban, high-rise apartment buildings subsidized by the U.S. Department of Housing and Urban Development. Lessons learned about structure, process, and outcomes in a community-based wellness center are identified and discussed.     

So near and yet so far: Lingering questions about the use of measures of general intelligence for college admission and employment screening.

The evidentiary bases for the various positions taken by the authors of articles in the March 2000 special theme issue of Psychology, Public Policy, and Law, are examined. Despite some substantive disagreements among the authors, a substrate of evidence is accepted (or, at the very least, goes unchallenged) by all authors. Although the substantial progress made by psychometric researchers is acknowledged, there remains a critical need to probe ever more deeply into the nature of intelligence and the meaning of correlations between ability tests and performance at school and at work. The author concludes by arguing that the concept of general intelligence may have considerable predictive usefulness whenever the situation calls for making a limited number of choices among many applicants but that there are lingering conceptual limitations about its meaning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk Adjustment for the Medicare program: lessons learned from research and demonstrations

The Balanced Budget Act (BBA) of 1997 requires numerous changes in Medicare. Medicare's managed care program has been reinvented as "Medicare + Choice," offering an expanded range of delivery system options for beneficiaries and a schedule of payment changes that will dramatically affect managed care plans. Preceding some of these BBA-legislated changes to Medicare were years of research and demonstrations. Risk-adjusted payment in the Medicare + Choice program, which is mandated for implementation in 2000, is one example of a longstanding developmental initiative. This paper provides a brief overview of risk adjustment-related research and demonstration activities carried out by the Health Care Financing Administration (HCFA) since the 1980s, and describes a possible technical approach for the implementation of risk-adjusted Medicare managed care payments in 2000.     

Deep venous thrombosis: incidence on admission to a brain injury rehabilitation program

OBJECTIVE: To determine the incidence of deep venous thrombosis (DVT) in brain injured individuals at time of admission to a brain injury (BI) rehabilitation program. DESIGN: Prospective study, sequential case series. SETTING: University tertiary care BI rehabilitation center. DATA SET: Eighty-two traumatic brain injury (TBI) and 71 atraumatic brain injury (ABI) patients were consecutively admitted to our BI unit over a 12-month period and screened within 24 hours of admission for a lower extremity DVT with color flow duplex Doppler ultrasonography. All patients had been prophylaxed with either subcutaneous heparin anticoagulation therapy or intermittent compression devices, and all patients were within 2 months of the original BI. MAIN OUTCOME MEASURES: Evidence of intrinsic venous occlusion by duplex Doppler. RESULTS: DVTs were detected and treated prior to rehabilitation admission in three patients (2%), and these persisted at rehabilitation admission. New DVTs were detected at time of rehabilitation admission in 17 patients (11%). All were occult DVTs; none of the 17 patients had clinical findings indicative of acute DVT. No significant differences were noted in the TBI group when age, highest 24-hour Glasgow Coma Scale score, length of acute hospitalization, type of DVT prophylaxis, or presence of an extremity fracture were compared for individuals with and without DVT. No significant differences were noted in the ABI group when age, length of acute hospitalization, and type of DVT prophylaxis were compared for individuals with and without DVT. CONCLUSION: The overall incidence of DVTs was 13% and the incidence of occult DVT was 11%. Individuals with TBI had an overall incidence of DVTs of 20% and an occult DVT incidence of 18%. Individuals with ABI had an overall incidence of DVT's of 6% and an occult DVT incidence of 4%. These findings indicate the importance of baseline screening for DVT in this patient population.     

The medtronic intact porcine valve: ten-year clinical review

OBJECTIVE: Our objective was to assess the long-term mortality and morbidity associated with the Medtronic Intact valve (Medtronic, Inc, Minneapolis, Minn). METHOD: Between 1983 and 1996, 447 patients (280 men and 167 women) received 466 Intact valves: 280 aortic, 156 mitral, and 30 tricuspid. The mean age was 57 years (median 63 years), with 45% younger than 60 years. The mean New York Heart Association class was 3.1. The follow-up was 98% complete and extended for 39 months (1-154 months) and 1324 patient-years. There were 32 valves at risk at 10 years after implantation. Doppler echocardiography was performed whenever possible in patients followed up for longer than 4 years (mean 8 years) after implantation. RESULTS: Ten-year overall actuarial survival was 30% +/- 6% (14% +/- 7% for New York Heart Association classes IV-V and 39% +/- 8% for classes I-III). At 10 years freedom from infective endocarditis was 92% +/- 3%, freedom from thromboembolism was 80% +/- 5%, and freedom from nonstructural valve deterioration was 95% +/- 2%. Ten-year freedom from explantation was 64% +/- 6%, freedom from valve-related events was 51% +/- 6%, and freedom from valve-related death was 88% +/- 3%. There were 26 examples of structural valve deterioration, mainly caused by leaflet calcification (in 17 cases) and by buttress detachment (in 6 cases). In the aortic position at 10 years freedom from structural valve deterioration was 81% +/- 9%, but with only 1 event in patients older than 40 years (freedom 92% +/- 8%) and 100% freedom in patients older than 60 years. There was also 100% freedom from structural valve deterioration in the tricuspid position. In the mitral position freedom was 65% +/- 8%, with no significant difference between age groups. CONCLUSION: The Intact valve provides superior results in the aortic position in patients older than 40 years and in the tricuspid position at all ages.     

The American Psychological Foundation: A ten-year report.

"In 1953, the American Psychological Foundation was launched by the APA as an instrument whereby psychologists could contribute financially to the continued development of psychology… . The most significant of the Foundation's early projects was the establishment of the Gold Medal Award, given to senior psychologists in recognition of a distinguished and long-continued record of scientific and scholarly accomplishment… . A 2nd award, instituted in 1956, goes to professional writers who have made outstanding presentations of psychological information in mass media." 2 tables indicate the financial history of APF and the distribution of contributions from individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting postdischarge opiate abstinence from admission measures of motivation and confidence.

Admission scores from a model comprising 3 motivation factors concerning the cessation of heroin use and a confidence scale concerning postdischarge abstinence were tested for their ability to predict postdischarge outcomes in patients beginning inpatient opiate detoxification. Statistically significant prediction of abstinence from heroin 30 days after discharge and the number of heroin-free days in the 3 months following admission was based on the confidence scale and a factor concerned with externally imposed constraints on continued heroin use. The single-scale confidence measure made the largest contribution to each prediction, indicating that such scales may be potentially useful outcome predictors for postdischarge abstinence. External constraints on heroin use may not provide a basis for success in this treatment modality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Oxford medial unicompartmental arthroplasty: a ten-year survival study

Retrieval studies have shown that the use of fully congruent meniscal bearings reduces wear in knee replacements. We report the outcome of 143 knees with anteromedial osteoarthritis and normal anterior cruciate ligaments treated by unicompartmental arthroplasty using fully congruous mobile polyethylene bearings. At review, 34 knees were in patients who had died and 109 were in those who were still living. The mean elapsed time since operation was 7.6 years (maximum 13.8). We established the status of all but one knee. There had been five revision operations giving a cumulative prosthetic survival rate at ten years (33 knees at risk) of 98% (95% CI 93% to 100%). Considering the knee lost to follow-up as a failure, the 'worst-case' survival rate was 97%. No failures were due to polyethylene wear or aseptic loosening of the tibial component. One bearing which dislocated at four years was reduced by closed manipulation. The ten-year survival rate is the best of those reported for unicompartmental arthroplasty and not significantly different from the best rates for total knee replacement.     

A research program for accountable and patient-centered health outcome measures

This article addresses the relevance of probabilistic conjoint (Rasch) measurement to five issues of accountability and patient-centeredness in health care. Goals for research, data quality standards, and standard metrics are proposed. The article is intended to begin to address concerns voiced by health care researchers, policy analysts, and the public about ways in which health care outcome measures can be improved.     

Outcome measures of a chronic pain program: a prospective statistical study

Ion beam enhanced deposition (IBED) was adopted to synthesize biocompatible titanium oxide film. Structure characteristics of titanium oxide film were investigated by RBS, AES, and XRD. The blood compatibility of the titanium oxide film was studied by measurements of blood clotting time and platelet adhesion. The results show that the anticoagulation property of titanium oxide film is improved significantly. The mechanism of anticoagulation of the titanium oxide film was discussed.     

Improving functional outcomes in older patients: lessons from an acute care for elders unit

BACKGROUND: Hospitalization often marks the beginning, and may be partially responsible for, a downward trajectory characterized by declining function, worsening quality of life, placement in a long term care facility, and death. At the University Hospitals of Cleveland, an Acute Care for Elders (ACE) unit that reengineered the process of caring for older patients (> or = 70 years of age) to improve functional outcomes was established in September 1990. DESCRIPTION OF INTERVENTION: The general principles of ACE included an approach to care guided by the biopsychosocial model and recognition of the importance of fitting the hospital environment to the patient's needs. The design of the intervention was consistent with principles of comprehensive geriatric assessment and continuous quality improvement. Care, which focused on maintaining function, was directed by an interdisciplinary team that considered the patient's needs both at home and in the hospital. The major components of the ACE Unit intervention included patient-centered nursing care (daily assessment of functional needs by nursing, nursing-based protocols to improve outcomes, daily rounds by a multidisciplinary team), a prepared environment, planning for discharge, and medical care review. RESULTS: In a randomized trial comparing ACE with usual care, patients receiving ACE had improved functional outcomes at discharge. The costs to the hospital for ACE unit care were less than for usual care. The functional status of ACE and usual care patients was similar 90 days after discharge. FUTURE DIRECTIONS: The ACE unit intervention is being expanded to preserve the improvements observed during the hospitalization in the outpatient setting. In addition, needs other than function which are critical to patients' long-term quality of life are being considered.     

The impact of a high dependency unit continuing education program on nursing practice and patient outcomes

Most evaluation studies of continuing education (CE) programs have concentrated on the assessment of learner knowledge and satisfaction and/or learner perceptions of change in professional competence and patient care, rather than on actual changes in nursing practice and patient outcomes. This study aimed to measure and compare frequency of nursing interventions and patient outcomes before and after a high-dependency (HD) CE program. A retrospective review of all HD patient records (n = 92) over the same 2-month periods in 1994 (n = 39) and 1995 (n = 53) was undertaken. Outcome variables were measured by assessing the incidence of cardiorespiratory complications, HD patient admission rates to critical care areas and process measures of nursing interventions with predetermined practice patterns. The before and after groups of patients were similar in age (mean 69 years), severity of illness (mean APACHE II = .12) and HD length of stay (mean 2.6 days). While the average number of critical events per patient was similar in both groups (before 2.03; after 1.96), complications resulting from critical events were 8 per cent fewer in the after group. The implementation and documentation of appropriate nursing interventions improved by 30 per cent following the introduction of the CE program (chi 2 = 25.53, df = 1, p < 0.001, 95 per cent CI 0.1804 to 0.4196, point estimate 0.3). The study revealed that there was a strong association between implementing the HD CE program and improved nursing practice. This may be related to the observed improvement in patient outcomes.     

Predicting parent and child outcomes of a filial therapy program.

The present study investigated parent and child factors that predict outcome in a filial therapy program for parents (N = 27) and young children (ages 2–10). Higher levels of parent distress and poorer child regulation of emotion at pretest were predictive of greater reductions in child behavior problems; poorer parent regulation of emotion at pretest was predictive of greater increases in parent acceptance; and less parent satisfaction with social support from family and friends at pretest was predictive of greater increases in parent communication of acceptance in parent–child play. Implications and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The role of standardized admission tests in the debate about merit, academic standards, and affirmative action.

This article examines two issues in the debate about affirmative action in higher education admission—merit and academic standards—from the perspective of the role of standardized testing in both fueling and informing that debate. The discussion includes summaries of selected affirmative action litigation cases in which test scores were central to the complaint and/or the defense, an evaluation of test-score use in the admission process, and a presentation of alternatives to standardized test scores for admissions. Attention is focused on the potential impact of those alternatives on diversity as well as on academic standards and merit. The article concludes with explication of current challenges to the testing community. Primary among these is the need to articulate meaningful measures of relevant admission factors that go beyond test scores and grades. Test theory and technology are capable or near capable of supporting a more comprehensive system to assess multiple factors, moving admission testing from the single test score to a battery or profile of strengths and weaknesses among applicants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)